In many Eastern countries mental health is a taboo and in the Punjab where Sikhism is prevalent, it is no different. As a member of the Sikh community and a psychology graduate, I have found mental health issues are brushed under the carpet and are not openly spoken about within the Sikh community, as well as other religions. However the younger members are becoming more open about mental illness. This begs the question is it a cultural or religious taboo.

Sikhism is a faith of One God, Ten Sikh Guru’s and the Holy Guru Granth Sahib Ji (GGSJ). Sikhs believe in Karma, and hence believe any tragedies or ill health is seen to be a result of bad karma in either this lifetime or a previous one. Seva (services to others) is also a key component of Sikhism as well as living a moral and ethical life is a key belief in Sikhism.

Culturally Sikhism is just like Hinduism and Islam, mental health is a taboo and there is a very evident discrimination against mental health. Families will conceal any one in their family with a mental illness or neurological defect (if possible). This idea of ‘family honour’ is a major issue amongst South Asians. The opinions of others is cast with very high importance, and it seems having a mental illness brings embarrassment to the family name, taints it and can leave the individual unlikely to marry due to its social impact.

Mental illness is not seen as an issue the GP can fix, it’s more of supernatural/spiritual issue. ‘Nazar’ (evil eye) is another major issue found amongst the south Asian community. The notion is someone has cast the ‘evil eye’ on you and your family. This belief of people casting an ‘evil eye’ as being the cause of an individual’s ill fate in life, is a phenomena which health care professional should take into consideration. Taking on board the cultural belief of the patient, and incorporating it in treatment plans, can help patients understand their diagnosis and be more acceptance to treatment.

Sikh’s believe in equality amongst human beings;

‘’ No one is Hindu or Muslim, all are children of God, so are equal’

(Guru Nanak Dev. Ji [8])

Here Guru Nanak Dev. Ji lays out the fundamental foundation of ‘’human rights for all of humanity’’ [8]. However, we do see hidden discrimination toward the ‘different’ and hence the individuals are cast out of the Sikh community.

However, Guru Nanak Dev. Ji, taught us to give up: pride and Haumai (ego) and to become humble. Guru Nanak Dev. Ji outlined Haumai is the greatest disease of humanity and that most of the global conflicts and the mental health epidemic is due to Haumai and pride. Guru Nanak Dev. Ji stated if we control our pride and Haumai, we can directly improve the mental health of the both the individual and the community [8].

It is this pride (self and family) being driven by egos, which is causing this taboo in mental health. If we let go of our ego’s and dismiss our own/family pride, we would be more acceptance of issues such as mental health. This removal of pride and ego, will not only benefit the individual but also the community for the long term. Also a global cultural change in attitudes towards mental health can occur, without the presence of negativity, judgement and discrimination.

From personal experience, working in the mental health sector, I have come to realise, there is an unspoken community of Sikhs suffering from mental illnesses such as; Depression, Anxiety, and Panic Attacks etc. Many of the individuals fail to recognise they have a mental health problem, and others put it down to a bi-product of their other medical illness; or medication. This was worrying for me, as a large population in the UK of Sikh individuals are dealing with an un-diagnosed/treated mental health issue.

This got me thinking:

‘’ How best can we support the mentally ill in a Sikh community who deny any problem’’?

• Using a culturally based model of counselling

• Respecting the daily routine of the individual

• Respecting the 5 K’s

• Support the family

Using a culturally based model of counselling

An abstract from the article written by Dr. Kala Singh (Singh, 2007):

‘’With the continuing migration of a large number of South Asians, especially the Sikhs, to Western countries, mental health professionals should be aware of their clients’ world-view and cultural/religious specific models of counselling. Use of Sikh spirituality can reduce stress; help in treating psychosomatic disorders; and improve mental health of the individual and of the community. [6]

Figure 1 Sikh Spiritual Model of Counselling [3]

Mental Health professionals should aim to use cultural specific models of counselling, to better support the individual. Understanding the Sikh religion/culture, will assist in implementing treatment plans more effectively. Also the individual is more likely to accept the diagnosis, treatment and speak about it more openly, as it’s within their religious understanding.

Dr Singh outlined mental health professionals should be self-aware of their own beliefs and values, to understand the perspective of all human beings based on different cultures. Then form this information plan and implement an appropriate intervention tailored for the individual [6].

This model is not just aimed at Sikhs, it is universal and can be used by other religions such as Hinduism and Christianity.The model is adaptable to people, situations and beliefs, which means the model can be used in conjunction with western beliefs as well as eastern beliefs, supporting those with conflicted views [1].

Respecting the daily routine of the individual

Individuals whom suffer from mental health issues, their family feel excluded from daily prayers and family occasions. However using the Sikh Spiritual Model of Counselling, prayer and medication adherence is encouraged, to help provide both spiritual, physical and medical support [1].

Respecting the 5 K’s

Baptised Sikhs and/or un-baptised Sikhs, whom are suffering from a mental illness, should maintain belief in the 5 K’s. This involves Kesh (refrain from cutting your hair), wearing the Kirpan (holy dagger), Kara (silver bangle), Keshara (shorts) and kanga (comb). The UK Sikh Healthcare chaplaincy group have special circumstances regarding the Kirpan, considering the situation. Ensuring all the 5 k’s beliefs are maintained can ensure the sanctity of a Sikh is not broken during this time [1].

Support for the family

Sikhs live and have very close families. Even though one individual is suffering from the mental illness, the reality is this is seen to have detrimental effects on the parents, partners, and siblings. It is imperative that immediate family are fully supported as well, so they are able to provide a strong network to help recovery of the individual and providing them with all the knowledge surrounding the condition [1].

More and more individuals from the South Asian communities are speaking up and raising awareness of mental health. Individuals across the globe have stood up against the discrimination and hush-hush nature of mental health and voiced their experiences. Many people are using their social platforms to dis-courage this stigma and encourage people talk about it and deal with the issue together, educating the next generation of Sikhs

So, living as a British Sikh, born I have a conflict between my western upbringing and the Sikh culture. For me I do not let my religious or cultural views impact my thought about mental health. But this doesn’t mean I escape the prejudice and discrimination in my family life.

Be it cultural or religious the future of South Asian Mental Health doesn’t look bleak. Through focussing on the individual’s religion and using this as the driving mechanism for treatment, mental health will be recognised and treated more effectively in these communities.

‘’if the human race is free from caste, creed, colour, religion and gender, there is equality amongst all human beings. If ego, pride and Haumai is removed, may mental health problems may be prevented’

“I can’t believe it I finally have overnight leave!! Gosh!! Oh my days!! This is a closer step towards discharge, because next will be two overnight leaves, than discharge……

I need to speak to the consultant I don’t want my overnight leave to be at my parents house any more, I want to go back to my supported living my own flat… last time I went home my dad picked me up with my mum and I cried all the way in the car journey……my dad was shouting at me saying this wouldn’t have happened if I would have stayed at home with them……my dad doesn’t understand that I moved out to get better, not party, smoke, drink and have sex…….

My dad emotionally abuses my mum who also isn’t mentally well herself…. she tries but she can’t stand up for me as my dad puts her down…

I don’t want to go back home…………..’’

Anonymous

Mental health is in its infancy in today’s society, perception and understanding towards it is still cautious. However treatment is available in abundance but access to resources fails the right people gaining the most out of the treatment. South Asian communities feel, not following parents rules, rituals and beliefs can lead to an ill-fated mental health diagnosis. Seeking help for this unknown territory is hard, often ignored and cases of abuse; emotional, physical, financial or neglect, occur due to lack of understanding

Many individuals up and down the country are in a similar situation to this person’s. For so long they have waited for the moment they receive positive news from the hospital, knowing that this is a step closer to discharge. However this positive step towards getting better comes at a great cost for some. Once out the hospital and back in the care of loved ones, they feel isolated and trapped. Loved ones fail to understand and recognise their mental health and blame the individual for the way they are.

Advice for anyone who can relate the above situation is stay positive, allow yourself to be happy that you are recovering. It’s not always easy to ignore what your loved ones saying but try and realise they may not understand. Help them understand sit down and speak to them, show them literature which can explain the mental illness, show them how you have recovered. Most of all like the individual in the statement above, recognise yourself that the situation your in is not the best for you, that it could set you back, realise you need to have distance to recover.

Everyone needs to stand up and speak up. Individuals like the one above need to be positive feel overjoyed and elated that they are doing well, but reality shows the opposite.

Let’s work together to help not only mental health sufferers but their families too.

There is a vast variety of coping strategies and relaxation techniques, which are all equally as effective. One such strategy is music therapy.

When we are stressed, we have a build of tension and emotion. Therefore there needs to be a release of this tension, to help cope with the stressor. Music is a great outlet, as singing along with your favourite song, pouring all your emotion into the song and singing at the top of your lungs. By doing this you are reliving your stress, especially when you feel overwhelmed, it’s an effective way to be mindful of yourself. An individual is able to loose themselves in the music and let go for a few moments.

I am a big advocate of music therapy as no matter who you are and what you’re going through, music is often a great distraction and outlet for emotion. Not many think of listening to music as an effective therapy tool, as they can’t make the link between emotion to music. Let’s put it into another perspective for example an individual feels alone, isolated and has no hope that anything good will occur. They may turn to physical self harm, alcohol, drugs or even attempt suicide. Now these are very valid coping mechanisms which people learn and implement. But they are very temporary and the after effect is always negative. However if the person decides to turn on some music and sing and pour the emotion out, there will be little need to reach for the bottle of whisky or packets of pills. As they have released their emotion, they may not have dealt with the situation but the emotion attached has been dealt with.

In life it’s not often the stressor that causes us stress but our perception of it, what it means to us, how it affects us etc. How we perceive something will then drive our emotions towards it. This build up of emotion than causes us to feel stressed, anxious etc. Consequently we than engage in any behaviour to help cope with the emotion. This is key! We forget about dealing with the emotion, how we are feeling, we often don’t have an effective outlet for it. For example deliberately lacerating your forearm will not help relieve the emotion but will help the person have a physical outlet to what they are feeling such as pain. They feel pain but can’t express it, lacerating can help place understanding to the pain they feel. But the critical point is the feeling of pain is not fully dealt with.

Therapy is an effective way of confronting the emotion, understanding our feelings and relieving the emotion attached.

Some may argue they don’t listen to music, which is a fair argument. Music therapy is just one method in hundreds, so if music is not for you maybe drawing or doing art being more expressive, may be more ideal for example.

Music therapy and such therapies are effective and work long term because you are releasing positive endorphins in your brain, you start to think less negatively and you feel you are more able to tackle the problem as you’ve released a lot of the emotion attached to it. This is an important aspect which a lot of people forget or don’t realise, we have a lot of emotional baggage attached to any given situation . If we are able to let go of the emotion; anger, sadness, pain etc we are only left with the problem. Our judgment and decision making is not clouded or blurred by emotion. We are more able to make rational and logical decisions and perceive the situation differently.

Pause. You might be reading this thinking this is wishful thinking and naive to think every situation can be solved so easily. Incorrect. Here I’m not saying every situation can be solved with this method of understanding emotion . Not at all. Here I mean to say, try using music in times of difficulty, try another coping mechanism which you haven’t tried. My message here is to offer another alternative strategy which is very effective. Just try it.

Music encompasses all the emotion we may feel at any given time. Not one song has only emotion attached to it, they vary in emotion throughout; they are mini journeys. This is what makes them effective, as the song successfully aids you through all the emotions and removes any extra feelings. For example when I feel angry I tend to reach for grime or hip hop music, as they reflect my mood more. But I find after a few songs or so, I maybe listen to some RnB and maybe ending up at pop music. By this time I don’t feel angry anymore but more calm and ready to think of a solution to the problem. At this point I’m not acting in anger or rage but a rational place. Yes in most circumstances this approach doesn’t work as we may need the emotion to help drive us to confront the problem.

Individuals with mental health conditions, use music a lot to escape reality, express their current thoughts/ feelings or to deal with their problems. The individual may have issues surrounding controlling or understanding their emotions and feelings. They are unable to identify them and express them to others. This is seen to be very effective in those suffering with depression.

Music is a great way of allowing others an indirect insight into your current mental state without communication. The listener will often understand what your feeling from the song which you play.

Music can also be used to be mindful and bring yourself, back to yourself. It can centre you and reign in your thoughts and feelings, focus them on one aspect, allowing you control again.

So next time you or someone you know is going to something, provide different options for coping and ask them to try methods which they haven’t yet explored. As you never know singing may be the one strategy which works ( they may even have a good voice).

This is a phrase which is all too often used. This statement is true and no one truly understands what another person is going through. It’s impossible. But we each have gone through the same or similar experience, this will therefore give us insight the thoughts, feelings and behaviours surroundings it.

Humans tend to be natural curious beings whom seek answers and will assume answers where there is none. This use of assuming is what we do all to often, everyday, to one another. We assume what a person is thinking, doing, saying, believing etc etc. For we tend assume when we don’t understand or have no answer. For example when we see someone running down a road, instantly we think of the scenario of why they are running. But why do we do that? The reason is we need to feel we understand the world around us and once we can do this than we can navigate through life.

But in doing so we never truly understand the world which is actually around us. Our current perception of the world is made up of our assumptions and perceptions of reality. But the reality is not being perceived as reality. In fact we cannot truly say we understand our reality.

So we can use and extend it to, we don’t really understand each other as human beings.

If you suffer from a physical condition or mental health condition, we assume the world doesn’t understand but the person in hospital with a similar diagnosis, understands me well. This is because you are going through the same battles and facing the world in a similar view. This is not 100% correct. Nobody can really understand what another is fully going through or feeling. But a person may be able to relate to your situation or feelings.

Life is a constant game which we all play but no one knows the rules. We make up our own moves, rules and players. So again why do we think we understand each other?

Humanity is a collective race, we have the need to feel part of a whole. Because there are many mysteries we face, and we cannot gain answers for them all. So we assume the individual sitting opposite me in school knows how boring the class is and how no one is listening to the teacher. But in actual fact the student might be activitively listening and enjoying the class. They may be thinking that you are also enjoying the class.

This highlights that everyone perceives the world from different realities at all times. We are continuously creating these false realities, in order to survive in our own reality. In doing so we are not living our true self as we have built our perception from assumptions and false thoughts.

So when an individual is cutting themselves, crying through the pain and feeling alone, they partially are correct. They are independent in their thoughts and ways of coping. But what we also fail to realise is the person who is trying to help them and support the through their tough times, is dependent on them. This means that we can’t assume no one understands. As overtime we have greater insight into others, therefore able to support and guide them. We spend our lives learning so we can understand. In times of distress and low points, we forget our human instinct.

I’m not stating we understand everything about each other, but we are able to be empathetic to someone or relate to some extent.

Let’s take the subjective nature of hearing voices. This is a phenomenon which can’t be proved or disproved. So on that basis the understanding we can have is vicariously through another’s explanation. Speaking from my experience of working in mental health, I can’t say I do understand hearing voices and the effect it has. But through working with individuals with voices and supporting them, I have built up a working knowledge that allows me to have some insight. Also to help implement coping strategies and distraction techniques.

When we begin to support others, we learn things about ourselves. We tend understand our emotions, how we react, our thoughts and our perception. It’s important to have this knowledge and to progress as a person.

The actual notion ‘no one understands’ is a statement said out of anger, fear and resentment. It’s a cry for help and the same time as closing up to the world. We need to support, guide and be patient with one another. This will lead to people understanding another and discovering themselves in the process.

Learned behaviour is any action that is undertaken by the individual to gain a desired outcome. For example Pavlov’s Dogs.

Conformity is the action of following unspoken rules or behaviours of any given group. To help answer our curiosity and assumptions. Also to mask our insecurities or lack of knowledge. For example Asch conformity experiment.

It’s very easy to conform to social norms, most times we don’t even realise we are doing it. It’s an innate mechanism in humans which makes us want to be apart of the collective and seek their approval. This can be in the form of agreeing with the majority even when you don’t agree , or crossing the road because a few other people do. When we hear the word conformity we all say ‘ I don’t conform I have my one mind’. So if we saw a large crowd standing still looking up what would your instinct be? To stand with them and look up. This is both curiosity and conformity. People often conform as they are curious why others have and what the outcome will be (social influence).

If everyone jumped of the cliff would you jump too? We’ve all this analogy time and time again. But it hides some truth in human nature. Humans are simple beings with complex mechanisms. This is an oxymoron of our lives. We are bound by social obedience.

An individual with suicidal ideations, maybe more inclined to follow social norms due to lack of control and the need to feel as apart of a group. This can be detrimental to their own mental health. For example if they perceive the majority to be self-harming, the need to be within a collective can cause the individual to also engage in self- harming behaviours. Here they will assume if the others are doing it than it must be right.

Let’s take the simple example of crossing the road because someone else has. Why do we follow that person do we assume they have a clearer vision than you of the road. Or are they taking the chance to get through? I myself have done this, followed others and I have also been the position where people have followed me. Here human beings assume the thoughts and actions of another person. What if the person who crossed out in the road hadn’t looked to see if it were safe? Or if they intend on hurting themselves? We are then in a vulnerable position ourselves because we assumed what their action meant.

In life we constantly assume, look for curiosity and conform to help us navigate through life. But it comes at a consequence. By conforming we are relying on others to for example keep us safe and control our lives. The concern is if we loose control of our lives, how are we meant to live?

An individual with a mental health condition will often feel a sense of no control and will look to others for guidance. This can both be positive and negative. If the look to professional or carers etc for guidance they receive filtered support and advice which lead them on the right path. However if they receive unfiltered guidance such as from others who are in a similar situation, they may be lead down a different negative path. The social influence of others and urge to be obedient can lead to undesired behaviours being learnt.

As you can see we have very simple innate behaviours but very complex mechanisms which drive it. So be confident and step out of line, make your decisions and choices based on you. Don’t look to others for guidance and someone is looking at you to for guidance.

This is everyone’s favourite quote when they can’t explain or want to justify something. In life we all go through ups and downs, that’s what life is. But when something negative happens, what is our perception, what do we think about it. Everyone has their way of coping with negative issues, some will; cry, get angry, withdraw in themselves, tell everyone (spilling), get up and carry on. For me I get upset, angry then brush myself off and move on.

Identifying your coping mechanisms, thoughts, feelings and behaviours when faced with a challenge or low point in life, can help you in the future. You are more likely to utilise all your tools and strategies that work. Mindfulness is an amazing tool which can help in so many ways. By focusing on your current present state, you are more likely to deal with your emotions/behaviours and gain control of yourself. It’s easy to get lost in our emotions and loose control. But taking the time to recognise it will help ease your stress levels.

Mindfulness can be done independently or with the aid of a secondary person. It helps put things into perspective and allow you take a step back and look at the problem from the outside. Allowing you the chance to realise the impact it has had on you.

Everyone has different coping mechanisms and level of tolerance. A person dealing with the reality they have been raped for example , this can often blur and alter your coping mechanisms. As what you thought would work, hasn’t and then you find yourself spiralling out of control, cognitively spilling and unable to get back control. In many ways you loose yourself in the process. You then reach a point in which you become so numb to how you feel you say “$#!+ happens”. NO. That quote highlights the fact you have given up hope and motivation to cope and get help. You have tried for so long and nothing has worked so you now accept this reality to be your life. NO.

No matter the severity of the negative issue, a person must always find a way to cope or deal with it. One way is to talk to someone, let them into your world and allow them access to your thoughts and feelings. In doing so the other person can understand to some extent the pain your going through. If they are aware they can maybe help and support you, using tools they have used themselves. Humanity is not a lone race but a collective, we feed off each other to survive. So turninlg to a person is going to help you.

Be careful of the label which you place on others such as; weird, stupid, odd, crazy, idiot or something more derogatory. These can be detrimental to their mental wellbeing or could reaffirm their own beliefs/fears. People can be very judgmental and place labels on others based on their ignorance, bias and fears. Labelling someone is placing a misconception or unwanted judgment on them without understanding the individual. They then perceive all of society sees them this way and will judge them before even getting to know them. This can lead to to social withdrawal and anxiety.

One main issue is the individual will begin to portray their label and they feel that’s the only way to manoeuvre in society free from further judgment. Causing the individual to feel more weighed down and overwhelmed by the label placed on them.

Many individuals such as those with mental health issues, can feel isolated and ashamed, due to the negative stigma and labels placed on them. Even though we are in the 21st Century, mental health is still a major taboo and is a topic of conversation not openly discussed. This can cause the individual to withdraw with themselves and cope with their pain by themselves.

You can find friends who see through the labels, to support you. We live in a very judgmental world where labelling someone is becoming more prevalent. Let’s make a change and tear down the notion of labelling people to mask our own insecurities and issues.

So we expect them to put a label on us or we label ourselves. This is to defend ourselves from the stigma attached to the label. If we presume this is what they are thinking, we can already begin to face it. For example someone who has a mental health diagnosis will call themselves “crazy”, offering the explanation “ I can say that as I’m crazy and they know I am”. Here the person is putting a label on themselves, as this is where they see themselves viewed in society.

It is hard to conduct in a confident way in a society where everything is stigmatised, judged and ridiculed. Any deviation from the “norm” is deemed “abnormal”. However ask yourself “ what does it mean to be normal?”.

In juxtaposition, some individuals will wear their label as a badge of honour and proudly confront society by showing their label to all. Again this is a coping mechanism, which one highlights they have an issue and two where they can hide behind it, almost a mask. For these individuals, the label/ stigma has been dealt with, leaving them scope to better deal with their concern.

If you place emphasis on an issue, everyone will notice. If you don’t place any emphasis, no one will know. This can refer to the label that maybe placed on a person. If you take the label and place a negative connotation on it, it will affect you. However if you embrace the label, then it won’t affect you.